Differentiating Ocular Functional Disorders: Hysteria Versus Malingering

Abstract

There is disagreement on the necessity or ability to sort out the intentional or unintentional nature of a patient’s functional disorder. Some clinicians believe it is clinically impossible. Others believe it is possible, but that providers should only determine that there is no basis for organic disease and allow primary care providers, psychiatrists, neurologists, or neuro-ophthalmologists to make further determinations. An outright diagnosis of malingering can cause conflict with such patients, and many providers believe that assuring the patient there is no sign of disease and to expect improvement is the best way to conduct the encounter. The diagnosis of malingering is a pejorative term and can potentially affect the patient’s long-term future regarding insurability, disability, and employability. Lastly, there is always the possibility of an incorrect or an evolving diagnosis. Studies vary widely, but suggest up to 11 % of patients diagnosed with hysteria either develop organic disease or have latent symptoms of organic disease that eventually become apparent.